Many low-income Californians who rely on Medicaid lost coverage for popular weight loss drugs at the start of the new year, as California and several other states move to curb soaring pharmaceutical costs by restricting access to GLP-1 medications such as Wegovy and Zepbound.
State health officials are now urging patients to pursue diet, exercise, and counseling instead of the heavily marketed drugs—guidance that obesity specialists say is often unrealistic for patients who have already tried those approaches without success.
“Of course he tried eating well and everything, but now with the medications, it’s better—a 100% change,” said Wilmer Cardenas of Santa Clara. Cardenas said his husband lost about 100 pounds over two years using GLP-1 drugs covered by Medi-Cal, California’s Medicaid program.
California’s decision reflects a broader national pullback as states confront rising drug prices, budget deficits, and looming Medicaid cuts under the Trump administration. Although the White House announced negotiated price reductions in November—touting “dramatically lower costs to taxpayers” and expanded Medicaid access—states are proceeding with coverage cuts that providers warn could harm patients’ health.
“It will be quite negative for our patients,” said Diana Thiara, medical director of the University of California–San Francisco Weight Management Program, noting that clinical data show most people regain weight after stopping GLP-1 medications.
As of Jan. 1, California, New Hampshire, Pennsylvania, and South Carolina stopped covering GLP-1 prescriptions for adult obesity treatment, while continuing coverage for conditions such as Type 2 diabetes, cardiovascular disease, and chronic kidney disease. Michigan, Rhode Island, and Wisconsin are planning or considering similar restrictions, according to a recent survey by KFF.
The shift reverses a recent expansion of coverage: as of October, 16 states covered GLP-1 drugs for obesity. That momentum now “appears to be waning,” KFF found, largely because of cost pressures. North Carolina rolled back coverage in October but reinstated it in December after court orders, despite ongoing budget shortfalls.
California officials estimate that continuing Medi-Cal coverage of GLP-1 drugs for weight loss would have driven costs to nearly $800 million annually within four years—more than quadrupling current spending. While Medi-Cal has covered weight loss medications since 2006, usage surged only in recent years. By 2024, the program covered more than 645,000 GLP-1 prescriptions across all approved uses.
Asked whether the state would reconsider in light of TrumpRx, a new federal portal offering discounted drugs, California officials said the policy is written into state budget law and will not change. Under the plan, Wegovy would cost consumers $350 per month, down from a list price of nearly $1,350, while Medicare and Medicaid would pay $245. However, health experts say the reductions are unlikely to meaningfully ease access for Medicaid patients.
“The out-of-pocket costs will still be very cost-prohibitive for most,” Thiara said, adding that manufacturers already offer some discounts that limit the impact of federal price negotiations.
About one in eight U.S. adults now takes a GLP-1 drug for obesity, disease, or both, according to a KFF poll released in November. More than half of users reported difficulty affording the medications, and many who discontinued treatment cited cost as the primary reason.
In guidance echoing other states, California health officials advised Medi-Cal members to consider “diet changes, increased activity or exercise, and counseling” as alternatives. But experts say those recommendations overlook the chronic nature of obesity.
“We definitely want patients to do their part with diet and exercise, but from a practical standpoint, that frequently is not enough,” said Kurt Hong, founding director of the Center for Clinical Nutrition at the University of Southern California’s Keck School of Medicine. He added that most patients seek medical help only after repeated failures with lifestyle changes alone.
While Medicaid coverage for adults has been cut, Medi-Cal members under 21 remain eligible for GLP-1 drugs for weight loss under federal requirements. Adults may still qualify if they can demonstrate medical necessity for conditions other than obesity, and denied patients can request a hearing. Others may pay out of pocket or seek discounts, or turn to newly approved oral weight loss drugs, which are expected to be cheaper than injectable versions.
For Cardenas and his husband, Jeffer Jimenez, whose prescription is tied to diabetes, coverage may continue—for now.
“He tried a thousand medications, pills, natural teas, exercise programs, but it doesn’t work like the injections,” Cardenas said. “You need both.”
